Following diagnosis of initial attack of rheumatic fever (RF), RF is considered active if any of the following is present Except:

Correct Answer: D

Rationale: The correct answer is D) Prolonged PR interval on ECG. In pediatric patients with rheumatic fever (RF), an active phase is characterized by the presence of certain clinical manifestations. These include fever, elevated acute phase reactants, and tachycardia. However, a prolonged PR interval on an ECG is not a defining feature of active RF. Fever of 38°C or more for 3 successive days is a common symptom of active RF due to the inflammatory response. A positive acute phase reactant, such as elevated C-reactive protein or erythrocyte sedimentation rate, indicates ongoing inflammation in the body. A sleeping pulse rate > 100 beats per minute is a sign of tachycardia, which can occur in RF due to cardiac involvement. Educationally, understanding the clinical manifestations of RF is crucial for pediatric nurses to provide appropriate care. Recognizing the signs of active RF helps in timely interventions and prevents complications. By knowing the specific criteria for diagnosing active RF, nurses can advocate for prompt treatment and monitoring to improve patient outcomes.

Correct Answer: C

Rationale: In this scenario, the most concerning diagnosis for a 3-day-old newborn presenting with jaundice, dark urine, and pale stools is C) Biliary atresia. Biliary atresia is a serious condition where there is a blockage or absence of the bile ducts inside or outside the liver, leading to the build-up of bile in the liver and eventually causing liver damage. It is crucial to identify biliary atresia early as timely intervention such as surgical correction can improve outcomes. Physiologic jaundice (option A) is common in newborns due to the immature liver function and is usually harmless, resolving on its own. Breastfeeding jaundice (option B) is often due to inadequate milk intake and does not typically present with dark urine and pale stools. Neonatal sepsis (option D) may present with jaundice but is usually accompanied by other signs of infection such as fever, poor feeding, or respiratory distress. Understanding the distinguishing features of different causes of jaundice in newborns is vital for pediatric nurses to provide timely and appropriate care. Recognizing the urgency of investigating and addressing biliary atresia can prevent serious complications and improve the infant's prognosis.

Correct Answer: D

Rationale: The correct answer is D) Group B Streptococcus (GBS) for being the most common cause of early-onset neonatal sepsis. GBS is a common bacterium found in the vaginal and rectal areas of women and can be transmitted to the baby during childbirth. It is a significant concern for newborns due to their underdeveloped immune systems. Option A) Escherichia coli is a common cause of late-onset neonatal sepsis, usually acquired postnatally from the environment or through contaminated breast milk. Option B) Listeria monocytogenes is often associated with foodborne illnesses, and while it can cause neonatal infections, it is not as common as GBS. Option C) Staphylococcus aureus can cause neonatal sepsis, but it is not as prevalent as GBS in the early-onset period. Understanding the most common causes of neonatal sepsis is crucial for pediatric nurses as it guides them in providing appropriate care, such as timely administration of antibiotics and close monitoring for signs of infection. Educating healthcare providers about these pathogens helps in early identification and management of neonatal sepsis, ultimately improving outcomes for newborns.

Correct Answer: B

Rationale: In this scenario, the most likely diagnosis for a neonate presenting with cyanosis and a boot-shaped heart on chest X-ray is Tetralogy of Fallot (TOF). TOF is a congenital heart defect characterized by four specific heart abnormalities that lead to cyanosis, including a ventricular septal defect, overriding aorta, pulmonary stenosis, and right ventricular hypertrophy. The boot-shaped heart appearance is due to the right ventricular hypertrophy seen on the X-ray. Option A, Transposition of the great arteries, involves aorta and pulmonary artery being switched, resulting in cyanosis, but it does not typically present with a boot-shaped heart. Option C, Total anomalous pulmonary venous return, involves abnormal connection of pulmonary veins to the right atrium, causing cyanosis, but it does not typically present with a boot-shaped heart. Option D, Tricuspid atresia, involves the absence of the tricuspid valve leading to cyanosis, but it does not present with the characteristic boot-shaped heart. Understanding these distinct features of each condition is crucial for nurses caring for pediatric patients. Recognizing the specific cardiac anomalies associated with TOF aids in prompt diagnosis and management to optimize patient outcomes. This educational context emphasizes the importance of thorough assessment, early recognition of clinical manifestations, and appropriate intervention in pediatric nursing practice.

Correct Answer: A

Rationale: In the context of pediatric nursing, understanding the clinical manifestations of Mycoplasma pneumonia is crucial for accurate assessment and diagnosis. The correct answer, option A, states that patients with Mycoplasma pneumonia can have a poor correlation between symptoms that are severe and minimal physical findings. This is because Mycoplasma pneumonia often presents with symptoms such as cough, fever, and malaise that can be disproportionate to the mild respiratory signs on physical examination. This discrepancy can lead to delayed diagnosis or underestimation of the severity of the illness. Option B, poor correlation between severe physical findings and minimal symptoms, is incorrect because Mycoplasma pneumonia is known for the reverse presentation where symptoms are more pronounced compared to physical exam findings. Option C, high-grade fever, is a common symptom of Mycoplasma pneumonia but does not address the specific aspect of the poor correlation between symptoms and physical findings seen in this condition. Option D, sudden onset of symptoms, is not typically associated with Mycoplasma pneumonia, as the illness usually has a more gradual onset compared to other acute respiratory infections. Educationally, this question highlights the importance of recognizing atypical presentations of common pediatric illnesses such as Mycoplasma pneumonia. It emphasizes the need for healthcare providers to consider a wide range of clinical manifestations and not rely solely on physical exam findings when assessing pediatric patients. By understanding these nuances, nurses and other healthcare professionals can provide more accurate and timely care to children with respiratory infections.